ArticleJournal of acquired immune deficiency syndromes (1999)2012
Permissive and protective factors associated with presence, level, and longitudinal pattern of cervicovaginal HIV shedding.
Article in Journal of acquired immune deficiency syndromes (1999), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed.
- Comparison of sampling methods to measure HIV RNA viral load in female genital tract secretions.American journal of reproductive immunology (New York, N.Y. : 1989) · 2017Trial
- Simultaneous plasma and genital pharmacokinetics and pharmacodynamics of atazanavir and efavirenz in HIV-infected women starting therapy.Journal of clinical pharmacology · 2015Trial
- Trial
- Longitudinal cervicovaginal bacteriome and virome alterations associate with discordant shedding and ART duration in women living with HIV in Peru.Nature communications · 2025Article
- Impact of Switching to Long-Acting Injectable Cabotegravir Plus Rilpivirine on Rectal HIV-1 RNA Shedding and Implications for Transmission Risk.The Journal of infectious diseases · 2025Article
- Crucial Role of Central Nervous System as a Viral Anatomical Compartment for HIV-1 Infection.Microorganisms · 2021Review
- Genital Shedding of Human Immunodeficiency Virus Type-1 (HIV) When Antiretroviral Therapy Suppresses HIV Replication in the Plasma.The Journal of infectious diseases · 2020Article
- Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma.AIDS (London, England) · 2020Article
- Evidence for both Intermittent and Persistent Compartmentalization of HIV-1 in the Female Genital Tract.Journal of virology · 2019Article
- Alcohol Use and HIV Disease Progression in an Antiretroviral Naive Cohort.Journal of acquired immune deficiency syndromes (1999) · 2018Article
- Risk of heterosexual HIV transmission attributable to sexually transmitted infections and non-specific genital inflammation in Zambian discordant couples, 1994-2012.International journal of epidemiology · 2017Article
- Low-level genital HIV shedding in Thai HIV-infected women with suppressed plasma viral load after menopause: a longitudinal study.Journal of virus eradication · 2017Article
- Vaginal HIV-1 shedding among HIV-1 infected women in the current era of combined antiretroviral therapy: A cross sectional study.Virulence · 2017Article
- Accurate measurement of female genital tract fluid dilution in cervicovaginal lavage samples.Journal of chromatography. B, Analytical technologies in the biomedical and life sciences · 2016Article
- Systemic Immune Activation and HIV Shedding in the Female Genital Tract.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Characterization of the Genital Microenvironment of Female Rhesus Macaques Prior to and After SIV Infection.American journal of reproductive immunology (New York, N.Y. : 1989) · 2015Article
- Compartmentalization, Viral Evolution, and Viral Latency of HIV in the CNS.Current HIV/AIDS reports · 2015Review
- Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa.Sexually transmitted infections · 2015Article
- Alcohol and HIV Effects on the Immune System.Alcohol research : current reviews · 2015Review
- HIV-1 shedding from the female genital tract is associated with increased Th1 cytokines/chemokines that maintain tissue homeostasis and proportions of CD8+FOXP3+ T cells.Journal of acquired immune deficiency syndromes (1999) · 2014Article
Corrections and comments
- Erratum issued
Authors and funding
16 authors.
Funding
Abstract
backgroundCervicovaginal HIV level (CV-VL) influences HIV transmission. Plasma viral load (PVL) correlates with CV-VL, but discordance is frequent. We evaluated how PVL, behavioral, immunological, and local factors/conditions individually and collectively correlate with CV-VL.
methodsCV-VL was measured in the cervicovaginal lavage fluid (CVL) of 481 HIV-infected women over 976 person-visits in a longitudinal cohort study. We correlated identified factors with CV-VL at individual person-visits and detectable/undetectable PVL strata by univariate and multivariate linear regression and with shedding pattern (never, intermittent, persistent ≥3 shedding visits) in 136 women with ≥3 visits by ordinal logistic regression.
resultsOf 959 person-visits, 450 (46.9%) with available PVL were discordant, 435 (45.3%) had detectable PVL with undetectable CV-VL, and 15 (1.6%) had undetectable PVL with detectable CV-VL. Lower CV-VL correlated with highly active antiretroviral therapy (HAART) usage (P = 0.01). Higher CV-VL correlated with higher PVL (P < 0.001), inflammation-associated cellular changes (P = 0.03), cervical ectopy (P = 0.009), exudate (P = 0.005), and trichomoniasis (P = 0.03). In multivariate analysis of the PVL-detectable stratum, increased CV-VL correlated with the same factors and friability (P = 0.05), while with undetectable PVL, decreased CV-VL correlated with HAART use (P = 0.04). In longitudinal analysis, never (40.4%) and intermittent (44.9%) shedding were most frequent. Higher frequency shedders were more likely to have higher initial PVL [odds ratio (OR) = 2.47/log10 increase], herpes simplex virus type 2 seropositivity (OR = 3.21), and alcohol use (OR = 2.20).
conclusionsAlthough PVL correlates strongly with CV-VL, discordance is frequent. When PVL is detectable, cervicovaginal inflammatory conditions correlate with increased shedding. However, genital shedding is sporadic and not reliably predicted by associated factors. HAART, by reducing PVL, is the most reliable means of reducing cervicovaginal shedding.
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